Desmopressin for Enuresis
Desmopressin is a manmade form of the body’s natural hormone vasopressin (vasopressin is also known as "antidiuretic hormone", or ADH). Desmopressin and vasopressin both act on the kidney as an “antidiuretic”, which means they cause the kidney to absorb more water, which means the body creates less urine. Vasopressin is important to prevent dehydration and it is also often released by the body at night to lower urine output, so sleep isn't interrupted. Desmopressin works in the same way and can help patients who have issues with bed wetting when it’s given just before bedtime. Desmopressin is actually FDA approved to treat nighttime bed wetting, which is also called enuresis.
What are the doses of Desmopressin used to treat enuresis?
0.2mg 30 minutes prior to bedtime. Do not drink any water at least 1 hour prior to bedtime.
Dose range is 0.2 to 0.6mg and only given at night.
Tabs come in 0.1 and 0.2mg doses.
What are the most common side effects of Desmopressin?
It is considered very safe and well tolerated, as it mimics a natural chemical in our body. A small percentage of kids may complain of:
-Headache
-Nausea
-Stomach upset
-Diarrhea
-Flushing of the face
Why is it important to not drink too much water just after taking Desmopressin?
For one, we want to avoid water at least 1 hour prior to bedtime to avoid having a full bladder overnight.
But it’s also important that the child never drink more than 8 ounces of water within 6 hours of taking the Desmopressin because the body is blocking the body’s ability to concentrate the urine. This can lead to too much water in the body, which can lead to lower sodium and other important ions in the body.
What are the most common comorbities in a child with enuresis?
-Psychiatric disorders such as ADHD, sensory issues, and anxiety.
-UTI: urinary tract infections.
-Snoring or sleep apnea— more rare but if you ever hear your child snoring or stopping breathing at night, a sleep study should be ordered.
-Constipation: if this is a major issue, the stool in the intestines can compress the bladder at night.
Should other conditions be worked up in a child with enuresis?
If it is stand alone and there are no other issues such as excessive thirst or other “bathroom”/toileting issues (such as daytime wetting or problems with defecation—called encopresis), then no further tests are indicated.
If there are concerns for excessive thirst, one must worry about diabetes or other endocrine abnormalities.
If there are concerns with multiple aspects of toileting, as mentioned above, please make sure to bring this up with your child’s pediatrician and consider a visit to the CHOP Dove clinic.
Why is enuresis so much more common in kids who also have ADHD?
The most common theories are that kids with ADHD have less mature neurologic systems, so the “connections” between their brain and bladder are not as well developed— this creates 2 issues:
-The signals from the brain to the bladder that help inhibit bladder function may not be as effective.
-The signals that go from the bladder to the brain may not be as effective. Indeed, many children with ADHD have various forms of sensory processing disorders and are less able to sense sensory input from many parts of their body.
-Another theory is that ADHD leads to changes in sleep that don’t allow the normal release of vasopressin, so the body produces more urine than it should, creating a fuller bladder.
